| NPI | 1003818600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NH 12594) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 217143) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2015-10-27 |