| NPI | 1336307123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 14492) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 14492) |
| 208D00000X General Practice (Licence: NE 17032) | |
| 208D00000X General Practice (Licence: IN 01033275A) | |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2008-05-28 |