| NPI | 1972839983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX P6253) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10034510) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: FL ME121851) | |
| 207W00000X Ophthalmology (Licence: MI 4301096427) | |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2026-02-07 |