| NPI | 1174785828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 70104) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 003117) |
| 207W00000X Ophthalmology (Licence: MI 4301100014) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2015-11-02 |