| NPI | 1891072963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2005031082) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 04-14238) |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2011-11-03 |