| NPI | 1255314191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: AZ 8149) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 8149) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2017-03-30 |