| NPI | 1174839583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2011017310) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL MFC1668) |
| Enumeration Date | 2010-08-23 |
| Last Update Date | 2015-05-19 |