| NPI | 1003873894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 17005) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 9300575) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2007-10-31 |