| NPI | 1629080239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 13621) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 20580) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2007-11-07 |