| NPI | 1326062381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MT 6044) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WY 4143A) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2015-01-08 |