| NPI | 1306467261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX W0563) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 202400614) |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2025-09-03 |