| NPI | 1831682962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2022-02923) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101287618) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2025-11-13 |