| NPI | 1609496439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME174501) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA 341634) |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2025-10-27 |