| NPI | 1811007313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MS D7311) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AL 00008686) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-12-31 |