| NPI | 1114970415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 40981) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IN 01056703A) |
| 207W00000X Ophthalmology (Licence: UT 61780601205) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2015-01-28 |