| NPI | 1952503864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301084269) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD438030) |
| Enumeration Date | 2007-06-03 |
| Last Update Date | 2014-07-17 |