| NPI | 1235371469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 9089290-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 56463) |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2014-09-22 |