| NPI | 1902010937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A051024) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A051024) |
| 208D00000X General Practice (Licence: CA A051024) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2015-06-20 |