| NPI | 1649434978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101036142) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: TX G6034) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2009-09-10 |