| NPI | 1073711479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PR 17209) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 62251) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2017-07-21 |