| NPI | 1083611883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DC MD5870) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD DOO17838) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-07-08 |