| NPI | 1114005972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 010245163) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DC MD039186) |
| 207W00000X Ophthalmology (Licence: MD D69882) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2011-10-26 |