| NPI | 1285808642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 250352) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2008-00396) |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2013-05-14 |