| NPI | 1356317879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G47767) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 30688) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2015-02-03 |