| NPI | 1538594379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ID O-1409) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ND 15906) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2021-05-06 |