| NPI | 1114236437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: PR 18288) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PR 18,288) |
| 261QS0132X Clinic/Center Ophthalmologic Surgery (Licence: PR 18,288) | |
| Enumeration Date | 2010-10-04 |
| Last Update Date | 2022-07-21 |