| NPI | 1629224795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 7457) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 7457) |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2008-08-08 |