| NPI | 1306962774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD167657) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2011-00921) |
| 207W00000X Ophthalmology (Licence: MI 4301100190) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2014-12-19 |