| NPI | 1205918273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G70452) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301053270) |
| 207W00000X Ophthalmology (Licence: MD D0063567) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2007-07-08 |