| NPI | 1124091251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 48082) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD16085) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2015-12-18 |