| NPI | 1437241346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WV 20564) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101231292) |
| 207W00000X Ophthalmology (Licence: SC 019996) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2012-07-16 |