| NPI | 1275795775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME106434) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX N2464) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2010-09-23 |