| NPI | 1851398168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 20412) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 31743) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2023-03-06 |