| NPI | 1376805341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA 15782) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 15782) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2012-06-14 |