| NPI | 1528029063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX M5024) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: RI MD11210) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2016-08-24 |