| NPI | 1396718565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL OS4720) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 91293) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2024-04-05 |