| NPI | 1891771812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 93961) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME81887) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2025-05-20 |