| NPI | 1881860013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101251330) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 141993) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2018-03-22 |