| NPI | 1366699555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 052940) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 7145) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2008-08-19 |