| NPI | 1215236419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 201401131) |
| Additional Taxonomies | 207WX0109X Ophthalmology Neuro-ophthalmology (Licence: NC 201401131) |
| 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: NC 201401131) | |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2019-10-01 |