| NPI | 1750479580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME117268) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC TL32873) |
| 207R00000X Internal Medicine (Licence: FL TRN10055) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2026-03-26 |