| NPI | 1164426730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 9600125) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101054116) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2015-03-06 |