| NPI | 1447598149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00036470) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ID M-8998) |
| 207W00000X Ophthalmology (Licence: OR MD-26380) | |
| 207W00000X Ophthalmology (Licence: CA C52196) | |
| 207W00000X Ophthalmology (Licence: NM MD2012-0678) | |
| Enumeration Date | 2013-01-30 |
| Last Update Date | 2013-01-30 |