| NPI | 1598962482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 356947-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 46712) |
| 207W00000X Ophthalmology (Licence: NM MD2013-0312) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2017-08-28 |