| NPI | 1023251881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA 40258) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA R-8531) |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2012-06-25 |