| NPI | 1588168488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD208110) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: OR MD208110) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2025-09-25 |