| NPI | 1497790018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A97142) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA 025662) |
| 207W00000X Ophthalmology (Licence: GA 061228) | |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2016-08-10 |