| NPI | 1508976358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DC MD6448) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D0016025) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2012-08-10 |