| NPI | 1881630887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL 91074) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AL 26662) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2018-08-28 |