| NPI | 1588227375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301508782) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4351044162) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2024-06-14 |