| NPI | 1770745960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME103710) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX G1918) |
| Enumeration Date | 2008-06-28 |
| Last Update Date | 2016-06-22 |