| NPI | 1730328410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 88629) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 5315031987) |
| Enumeration Date | 2009-02-19 |
| Last Update Date | 2024-08-27 |