| NPI | 1194164517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL OS12404) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL OS12404) |
| 207W00000X Ophthalmology (Licence: PA OS016632) | |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2021-01-25 |