| NPI | 1538216239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN 0013888) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MS 12279) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2020-05-04 |