| NPI | 1154884716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AL MD.41009) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2025-01987) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2025-12-30 |