| NPI | 1023378809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME37503) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AL MD12969) |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2012-05-25 |