| NPI | 1699781138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NM 93-313) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX H7630) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2011-12-18 |