| NPI | 1487641817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ND 6710) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 36803) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2007-10-17 |