| NPI | 1699084723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PR 19345) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 41875) |
| 207W00000X Ophthalmology (Licence: TX BP10054386) | |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2016-11-14 |