| NPI | 1891866679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60070926) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 49193-20) |
| 207W00000X Ophthalmology (Licence: UT 6861546-1205) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2024-01-03 |