| NPI | 1114053717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 231609) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MT183428) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2013-09-20 |