| NPI | 1407802713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SD 5762) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 27646) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2015-04-16 |