| NPI | 1225087661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA 19204) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 24360) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2011-01-12 |