| NPI | 1023067196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL 0S8658) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL 0S8658) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2008-01-11 |