| NPI | 1174866495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME156739) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ZZ 84035) |
| 208D00000X General Practice (Licence: ZZ 122163) | |
| 207W00000X Ophthalmology (Licence: IL 036.138324) | |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2025-03-20 |