| NPI | 1386177574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN 65999) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OK 38005) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2023-05-30 |