| NPI | 1194810291 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DC MD15592) | 
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101036839) | 
| 207W00000X Ophthalmology (Licence: MD D0036582) | |
| Enumeration Date | 2006-10-04 | 
| Last Update Date | 2007-07-08 |