| NPI | 1770684938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA C37054) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA C37054) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2014-08-20 |