| NPI | 1790896660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NV 14252) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 49198431205) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2016-10-10 |