| NPI | 1215321427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX S3884) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AR E-12069) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2023-01-17 |