| NPI | 1336300458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO 51040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301092703) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2012-11-29 |