| NPI | 1467657866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 32113) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 37269) |
| 207W00000X Ophthalmology (Licence: NC 2015-00164) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2017-05-26 |