| NPI | 1245222850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA L011487) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME86326) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2022-07-21 |