| NPI | 1962453480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME119496) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 47076) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2026-04-24 |