| NPI | 1629638374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MT219051) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MT219051) |
| Enumeration Date | 2019-06-15 |
| Last Update Date | 2019-06-15 |