| NPI | 1003075094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX N7917) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX N7917) |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2016-04-21 |