| NPI | 1609852441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO 42961) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 215374) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2018-07-26 |