| NPI | 1760488837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO R5J65) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 0427169) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2023-03-28 |