| NPI | 1861617284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AK 6199) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NM 70-30) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2009-01-28 |