| NPI | 1043308372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ND 5102) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 29919) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-12-12 |