| NPI | 1275532772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME79899) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: FL me7899) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2026-04-24 |