| NPI | 1184282048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 81140) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 5151013622) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2023-07-10 |