| NPI | 1184983025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VT 042.0016538) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D31508) |
| Enumeration Date | 2012-05-13 |
| Last Update Date | 2023-02-10 |