NPI | 1205725850 |
---|---|
Entity Type | Individual |
Gender | N/A |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 94989) |
Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 94989) |
Enumeration Date | 2025-06-30 |
Last Update Date | 2025-06-30 |