| NPI | 1174531875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301050280) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301050280) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2012-03-29 |