| NPI | 1013951698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 106423) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO 106423) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2026-01-21 |