| NPI | 1215093125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A107504) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 231585) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2019-10-03 |