| NPI | 1255368536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PR 14835) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2006010972) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2009-12-11 |