| NPI | 1205874641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DC MD13449) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D0038852) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2007-11-21 |