| NPI | 1649265497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VT 042-0010054) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NH 10966) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2016-08-08 |