| NPI | 1316155864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301095618) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WV 23493) |
| 207W00000X Ophthalmology (Licence: VA 0101244950) | |
| 207W00000X Ophthalmology (Licence: NC 2009-01191) | |
| 207W00000X Ophthalmology (Licence: LA MD.203172) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2011-01-20 |