| NPI | 1104388826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX U4917) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: NM MD2025-0504) |
| 207W00000X Ophthalmology (Licence: TX U4917) | |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2026-03-05 |