| NPI | 1457654469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 18) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 000018) |
| Enumeration Date | 2010-12-13 |
| Last Update Date | 2010-12-13 |