| NPI | 1710995543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 29610) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC NC200201921) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2021-05-04 |