| NPI | 1083817647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MT 18600) |
| Additional Taxonomies | 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: MT MED-PHYS-LIC-18600) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2020-09-17 |