| NPI | 1508397613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 89366) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA 309276) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2021-07-12 |