| NPI | 1447578752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MS 23717) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AL MD.33192) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2026-05-15 |