| NPI | 1356373047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD28139) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 054589) |
| 207W00000X Ophthalmology (Licence: WA 600001651) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2010-05-21 |