| NPI | 1659541381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PR 17834) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2008-00245) |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2010-05-07 |