| NPI | 1093715252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 23360) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 37479) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2021-03-15 |