| NPI | 1689202525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2026-02456) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: NC 2026-02456) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2026-05-01 |