| NPI | 1215190400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR DO153933) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 5101017970) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2019-05-02 |