| NPI | 1487657334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SD 1389) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NE 17531) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2008-11-04 |