| NPI | 1396737219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 36511) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AR E-0195) |
| 207W00000X Ophthalmology (Licence: KS 04-28667) | |
| 207W00000X Ophthalmology (Licence: TN MD0000035976) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2020-07-06 |