| NPI | 1982896056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX N6344) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX N6344) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2023-09-11 |