| NPI | 1205725850 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 94989) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 94989) |
| Enumeration Date | 2025-06-30 |
| Last Update Date | 2025-06-30 |