| NPI | 1356320568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: LA MD02687) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX M3563) |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2026-08-18 |