| NPI | 1265642482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA MD202072) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MS 18991) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2018-03-17 |