| NPI | 1942707690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101267537) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2023-06-07 |