| NPI | 1821082413 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35040584)  | 
| Additional Taxonomies | 207WX0110X Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist (Licence: OH 35040584)  | 
| Enumeration Date | 2005-09-09 | 
| Last Update Date | 2025-04-24 |