| NPI | 1275263972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AL 53870) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL88197) |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2026-09-03 |