| NPI | 1801895172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL 0054394) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL me0054394) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2018-02-13 |