| NPI | 1962403105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX J7048) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 33357) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2013-10-15 |