| NPI | 1740275775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AR C8269) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO MD104152) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2013-06-27 |