| NPI | 1275510885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN 41220) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VT 042-0010602) |
| 207W00000X Ophthalmology (Licence: NY 228400-1) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2007-11-08 |