| NPI | 1649775214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 73437) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 291595) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2023-08-16 |