| NPI | 1891752812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NM MD2005-0470) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 35249) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2012-05-04 |