| 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 |