| NPI | 1477879062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WY 6046A) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA G34211) |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2010-04-08 |