| NPI | 1023019502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD09829) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD00026268) |
| 207W00000X Ophthalmology (Licence: ID M-6100) | |
| 207W00000X Ophthalmology (Licence: CA G33242) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2013-01-22 |