| NPI | 1942604038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NV MED-LIC-2408) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MT MED-PHYS-LIC-3094) |
| 208D00000X General Practice (Licence: MT MED-PHYS-LIC-3094) | |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2014-10-17 |