| NPI | 1285615369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 27314) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 9400509) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2017-05-09 |