| NPI | 1558979161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 286493) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 283165) |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2021-03-08 |