| NPI | 1225152192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AL MD.29630) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX M2116) |
| 207W00000X Ophthalmology (Licence: FL ME100306) | |
| Enumeration Date | 2007-03-18 |
| Last Update Date | 2019-05-07 |