| NPI | 1508839424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC MD83485) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD425755) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2023-12-14 |