| NPI | 1164473682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO 26757) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NM A1218-03) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2007-07-09 |