| NPI | 1427056548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL OS 1590) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 29764) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2011-08-25 |