| NPI | 1215935754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA 19347) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 33427) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2007-07-08 |