| NPI | 1568501716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX J0618) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX J0618) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2017-05-26 |