| NPI | 1346263126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NM 98290) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX M6187) |
| 207W00000X Ophthalmology (Licence: CA G080256) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2009-11-28 |