| NPI | 1578684007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN 15512) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MS 09113) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2022-09-01 |