| NPI | 1104815794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DC MD4319) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101022547) |
| 207W00000X Ophthalmology (Licence: MD D0017297) | |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2007-07-08 |