| NPI | 1790727626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN MD0000025588) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MS 14348) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2026-08-04 |