| NPI | 1659542801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC TL31098) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101245181) |
| 207W00000X Ophthalmology (Licence: NY 226841) | |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2010-01-06 |