| NPI | 1811265887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NV 2198) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NV 2198) |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2011-12-06 |