| NPI | 1992330021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A201612) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: CA A201612) |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2025-07-08 |