| NPI | 1336360593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 18235) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 18390) |
| 207W00000X Ophthalmology (Licence: AZ 22114) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2011-10-12 |