| NPI | 1629277876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A125161) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD 21984) |
| 207W00000X Ophthalmology (Licence: MA 243445) | |
| 207W00000X Ophthalmology (Licence: VT 042.0012411) | |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2014-07-17 |