| NPI | 1891887394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME97791) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY R0838) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2017-04-05 |