| NPI | 1902809593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 39203) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 39203) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2022-09-16 |