| NPI | 1417949918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 232530) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD022472E) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2011-10-31 |