| NPI | 1821204207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MA 243559) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: RI DO00851) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2026-01-29 |