| NPI | 1689757254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DC MD13643) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D18526) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2020-01-02 |