| NPI | 1861666059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A109166) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD157095) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2022-01-13 |