| NPI | 1780604322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX D9066) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX D9066) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2019-08-29 |