NPI | 1700379203 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD61515298) |
Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 318445) |
Enumeration Date | 2018-06-08 |
Last Update Date | 2024-04-22 |