| NPI | 1568882389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 202000656) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101283509) |
| Enumeration Date | 2014-04-19 |
| Last Update Date | 2025-03-16 |