| NPI | 1417074139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2007-00382) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301083516) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-10-05 |