| NPI | 1093785313 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 204924) | 
| Additional Taxonomies | 174400000X Specialist (Licence: MA 204924) | 
| Enumeration Date | 2006-01-26 | 
| Last Update Date | 2015-12-15 |