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 |