| NPI | 1902133432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO R6635) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R6635) |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2011-12-13 |