| NPI | 1255515623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2013-00309) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 002830) |
| 207W00000X Ophthalmology (Licence: FL ME 109207) | |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2016-09-26 |