| NPI | 1932107018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DC 14897) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DC MD14897) |
| 207W00000X Ophthalmology (Licence: MD D0036917) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2017-01-11 |