| NPI | 1134123565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SD 2349) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ND 4569) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2015-01-28 |