| NPI | 1003803206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 04266R) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 04266R) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2018-12-13 |