| NPI | 1700379203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD61515298) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 318445) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2026-04-29 |