| NPI | 1215322573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 1540) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX T3764) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2024-05-25 |