| NPI | 1003991332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301099887) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 97-01804) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2012-01-19 |