| NPI | 1902073547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA MD.206529) |
| Additional Taxonomies | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: LA MD.206529) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2018-05-14 |