| NPI | 1407844616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD042342E) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: PA 6000006421) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2009-11-18 |