| NPI | 1912225392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: GA 76141) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2014008993) |
| 207W00000X Ophthalmology (Licence: GA 76141) | |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2018-03-17 |