| NPI | 1952308769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AR R-2493) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO MD105325) |
| 207W00000X Ophthalmology (Licence: TX E1330) | |
| 207W00000X Ophthalmology (Licence: CA A24052) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-11-21 |