| NPI | 1316937097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 33564) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 02394) |
| 207W00000X Ophthalmology (Licence: IL 036101686) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2008-02-04 |