| NPI | 1871868190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301109121) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX BP10047539) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2016-08-22 |