| NPI | 1053051953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC LL87552) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2026-02712) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2026-06-01 |