| NPI | 1285684894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 34067) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 15542) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2014-01-15 |