| NPI | 1043419914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SD 7858) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NE 5720) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2012-06-14 |