| NPI | 1306064324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA 3892) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 34-8629) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2008-06-03 |