| NPI | 1598184525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MT MED-PHYS-LIC-88298) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD199568) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2022-04-15 |