| NPI | 1578605002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD D0026047) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DC MD15870) |
| 207W00000X Ophthalmology (Licence: NC 26783) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-07-08 |