| NPI | 1508829227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX G2150) |
| Additional Taxonomies | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: TX G2150) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2020-01-06 |