| NPI | 1295995264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD160071) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 6808639-1205) |
| 207W00000X Ophthalmology (Licence: MA 246825) | |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2012-10-03 |