| NPI | 1215151097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 109644) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CO DR.0059066) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2023-04-04 |