| NPI | 1679964324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 29723) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NM MD2021-0820) |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2021-08-05 |