| NPI | 1457456386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: RI 6734) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 220290) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2009-08-28 |