| NPI | 1003238643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A46330) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 24201) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2024-04-27 |