| NPI | 1164554671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2007-00445) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA MD - 199903) |
| Enumeration Date | 2007-03-10 |
| Last Update Date | 2007-10-09 |