| NPI | 1124311311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 37867) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 75108) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2023-11-27 |