| NPI | 1467654202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD D70313) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: RI LP01182) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2011-01-29 |