| NPI | 1447412945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MS 21002) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TN MD0000045703) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2012-09-19 |