| NPI | 1003056516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A117900) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX N5775) |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2017-02-22 |