| NPI | 1033293451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME104277) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MS 19330) |
| 207W00000X Ophthalmology (Licence: TX M9496) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2009-07-21 |