| NPI | 1235303504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN 34932) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX k6307) |
| 207W00000X Ophthalmology (Licence: NC 200101131) | |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2008-04-17 |