| NPI | 1861887473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD.61394322) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301117497) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2025-12-03 |