| NPI | 1073594818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 8062924-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD00043676) |
| 207W00000X Ophthalmology (Licence: IA 38787) | |
| 207W00000X Ophthalmology (Licence: AZ 45603) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2014-01-21 |