| NPI | 1700444544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME161382) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 94279) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2025-06-09 |