| NPI | 1659324267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0109X Ophthalmology, Neuro-ophthalmology (Licence: VA 0101048960) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101048960) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2020-08-18 |