| NPI | 1255350005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME47476) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL 47476) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2019-05-08 |