| NPI | 1104814656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AR R2008) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR R2008) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2013-10-10 |