| NPI | 1396756847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G78490) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CA G78490) |
| 208200000X Plastic Surgery (Licence: CA G78490) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2007-11-14 |