| NPI | 1063695831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 40125) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD026362E) |
| Enumeration Date | 2007-12-14 |
| Last Update Date | 2024-07-26 |