| NPI | 1760749584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35129050) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA PGY.202083) |
| 207W00000X Ophthalmology (Licence: DC 1760749584) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2016-10-25 |