| NPI | 1225238561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ID M11420) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OK 25770) |
| 207W00000X Ophthalmology (Licence: TN MD0000045920) | |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2012-09-17 |