| NPI | 1821559667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 32796) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 32796) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2026-07-27 |