| NPI | 1962504514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 297470) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 032186) |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2021-08-05 |