| NPI | 1912110230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 7928404-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WV 23582) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2021-12-20 |