| NPI | 1407883838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 26341) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301064568) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2013-03-26 |