| NPI | 1699747956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD429809) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 101052051) |
| 207W00000X Ophthalmology (Licence: AZ 31377) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2026-03-27 |