| NPI | 1306939863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: HI 5483) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 22869) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2007-07-08 |