| NPI | 1750463469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO R7D82) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 0521009) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2015-02-23 |