| NPI | 1053326777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 200300209) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101234127) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2018-05-31 |