| NPI | 1316049265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 71682-20) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH OH 35 084276) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2024-04-22 |