| NPI | 1457320020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 9901116) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 21278) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2013-01-03 |