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 |