| NPI | 1508241209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO TL.0005920) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DC MTL002799) |
| 207W00000X Ophthalmology (Licence: VA 0116028520) | |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2016-06-30 |