| NPI | 1609801604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA OS014072) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 5101015865) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2023-03-29 |