| NPI | 1255336491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD14729) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD00025035) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2007-07-13 |