| NPI | 1003251984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DC mt203433) |
| Additional Taxonomies | 281P00000X Chronic Disease Hospital |
| 282NC0060X General Acute Care Hospital, Critical Access | |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2019-12-26 |