| NPI | 1124099122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 7319) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 17435) |
| 207W00000X Ophthalmology (Licence: GA 014859) | |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2007-10-22 |