| NPI | 1659735280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 85931) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WV 29684) |
| Enumeration Date | 2016-04-10 |
| Last Update Date | 2021-08-03 |