| NPI | 1255498366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DE C1-0008191) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD435384) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2020-07-08 |