| NPI | 1588653703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME32083) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME0032083) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2021-03-22 |