| NPI | 1891958328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2016012564) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 37905) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2017-03-27 |