| NPI | 1063546836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL LL712) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D0006137) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2022-07-21 |