| 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 |