| NPI | 1740279660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN MD0000014954) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 27981) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2009-04-21 |