| NPI | 1124074190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 36057) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD26123) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2013-07-13 |