| NPI | 1124106786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MT 7816) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CO 29408) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-03-22 |