| NPI | 1619907813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: KY 19046) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 19046) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2020-05-15 |