| NPI | 1881703924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 25403) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 25403) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-03-24 |