| NPI | 1598339202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2026-02193) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D0103080) |
| 207W00000X Ophthalmology (Licence: SC 96452) | |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2026-07-11 |