| NPI | 1124281431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX T7287) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 9406986) |
| 207W00000X Ophthalmology (Licence: MO 2012022163) | |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2023-04-10 |