| NPI | 1225171952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PR 15856) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15856) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2018-06-29 |