| NPI | 1477110799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC MD92000) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 13359512-1205) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2024-09-12 |