| NPI | 1124094651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: MI 4301089523) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301089523) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2025-05-06 |