| NPI | 1205891512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2006-00474) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC TL28671) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2009-09-22 |