| NPI | 1720160922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 057122) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2008-01722) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2010-10-06 |