| NPI | 1104838697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 042043) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 035629) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2010-01-27 |