| NPI | 1124182662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 225926) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A89132) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2010-08-04 |