| NPI | 1932100799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 10706R) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MS 14895) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2011-09-27 |