| NPI | 1003487372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME173393) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 97085) |
| Enumeration Date | 2021-07-07 |
| Last Update Date | 2026-08-31 |