| NPI | 1497724959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35-045315) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101030207) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2013-12-31 |