| NPI | 1205147634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX Q3512) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 8971169-1205) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2015-08-19 |