| NPI | 1891734117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX N5193) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD428457) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2022-04-13 |