| NPI | 1194962431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX D7166) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NM 89251) |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2009-01-08 |