| NPI | 1245467687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A34789) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX 0034789) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2023-11-27 |