| NPI | 1720342108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MS T2617) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MS 23881) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2023-07-13 |