| NPI | 1881980142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 9323355-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2011018948) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2021-02-18 |