| NPI | 1639457500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G18587) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX E5612) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2011-07-26 |