| NPI | 1376742957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA MD.201176) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CT 046489) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2010-06-07 |