| NPI | 1043504681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR 170561) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA 135745) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2015-07-16 |