| NPI | 1639600927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 286882) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: CT 75452) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2025-09-02 |