| NPI | 1306018288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME35702) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301037079) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2008-03-31 |