| NPI | 1235127713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 059602) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 200500892) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2016-03-30 |