| NPI | 1760877906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A176645) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD467131) |
| 207W00000X Ophthalmology (Licence: NJ 25MA10896300) | |
| Enumeration Date | 2015-04-04 |
| Last Update Date | 2024-07-02 |