| NPI | 1992788269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 31613) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NH 7743) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2007-07-08 |