| NPI | 1053828855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 37332) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME167188) |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2026-09-02 |