| NPI | 1467563312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA 39178) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA ML20007576) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2010-09-28 |