| NPI | 1912078064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DC MD4291) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D0016476) |
| Enumeration Date | 2006-11-12 |
| Last Update Date | 2018-02-22 |