| NPI | 1245405240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD D74254) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA 200223) |
| 207W00000X Ophthalmology (Licence: TX N4128) | |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2016-06-13 |