| NPI | 1184064669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 305565) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 5101020769) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2017-11-03 |