| NPI | 1174619696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: HI 2263) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD012657E) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |