| NPI | 1891016796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101266036) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NE 26377) |
| 208D00000X General Practice (Licence: NE 26377) | |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2019-07-31 |