| NPI | 1013127075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD29182) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO BB4745785) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2024-10-25 |