| NPI | 1821617564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 13798865-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 335511) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2025-12-23 |