| NPI | 1497769624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI PS066663) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301066663) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2014-03-10 |