| NPI | 1568482578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX M3727) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2006031059) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2014-06-02 |