NPI | 1750822185 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 74056) |
Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD61495259) |
207W00000X Ophthalmology (Licence: OR MD218340) | |
Enumeration Date | 2017-03-18 |
Last Update Date | 2024-08-22 |