| NPI | 1376971556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME121631) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 73461) |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2024-08-06 |