| NPI | 1205837010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 32367) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WY 7754A) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2008-04-07 |