| NPI | 1922595636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 12667018-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2026-03305) |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2026-07-15 |