| NPI | 1154362077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 0841684) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 0923537) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2011-06-24 |