| NPI | 1164586616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 235488) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 224712) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2010-08-30 |