| NPI | 1942689690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 38225) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA MD-49615) |
| 207W00000X Ophthalmology (Licence: GA 086300) | |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2025-03-19 |