| NPI | 1326242355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2011-01601) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2011-01601) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2025-04-21 |