| NPI | 1366456089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO DR.0023020) |
| Additional Taxonomies | 174400000X Specialist (Licence: WY 7567A) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2022-07-21 |