| NPI | 1891799839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 3089527-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ID M-8844) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: UT 3089527-1205) | |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2017-03-09 |