| NPI | 1972921864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101267228) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D0091753) |
| 207W00000X Ophthalmology (Licence: OH 35.133072) | |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2025-10-16 |