| NPI | 1497806251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX L5792) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OK 23863) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2008-01-30 |