| NPI | 1558327262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO R7571) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 0417025) |
| 207W00000X Ophthalmology (Licence: IA 18621) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2012-05-07 |