| NPI | 1962497826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN MD30047) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A63430) |
| 207W00000X Ophthalmology (Licence: FL ME84619) | |
| 207W00000X Ophthalmology (Licence: MS 18014) | |
| 207W00000X Ophthalmology (Licence: NY 295577-1) | |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2021-04-13 |