| NPI | 1558707851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 269931) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A135590) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2017-06-07 |