| NPI | 1205192168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.135789) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 250765) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2021-01-10 |