| NPI | 1720972334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD489386) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DE C1-0028100) |
| 207W00000X Ophthalmology (Licence: NJ 25MA12621700) | |
| Enumeration Date | 2025-06-06 |
| Last Update Date | 2025-11-26 |