| NPI | 1922213107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA md434452) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101243413) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2008-08-04 |