| NPI | 1295787141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101242140) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD00043996) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2008-02-13 |