| NPI | 1538143516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 25882) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 26691020) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2011-10-24 |