| NPI | 1306836705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00039323) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ID M8239) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2008-04-30 |