| NPI | 1235109802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 8984) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 19545) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2007-10-22 |