| NPI | 1679731590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A109505) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD456377) |
| 207W00000X Ophthalmology (Licence: CO DR.0067286) | |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2021-11-09 |