| NPI | 1154500726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 25802) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301091926) |
| 207W00000X Ophthalmology (Licence: IA 40169) | |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2012-12-10 |