| NPI | 1558359554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MN 37846) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 37846) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2026-02-25 |