| NPI | 1548266489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD051320L) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: PA MD051320L) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2008-01-23 |