| NPI | 1023166345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO 45574) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A90950) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2009-12-03 |