| NPI | 1497508642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 80140) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: FL 39157) |
| Enumeration Date | 2024-04-08 |
| Last Update Date | 2025-07-23 |