| NPI | 1427212992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MS 20923) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MS T-2110) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2021-03-31 |