| NPI | 1609440353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101285545) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DC MD600003798) |
| 207W00000X Ophthalmology (Licence: MD D0103161) | |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2026-01-14 |