| NPI | 1477564169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL 29394) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL 0949066) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2019-01-31 |