| NPI | 1225666308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD484677) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MP 0927) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-02-07 |