| NPI | 1740285832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 28184) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TN MD0000032268) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2023-11-30 |