| NPI | 1417121054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A131108) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR 184359) |
| 207W00000X Ophthalmology (Licence: FL 119840) | |
| 207W00000X Ophthalmology (Licence: TN 48379) | |
| 207W00000X Ophthalmology (Licence: AR E7446) | |
| 207W00000X Ophthalmology (Licence: WA 60462016) | |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2022-07-21 |