| NPI | 1508042060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 57019) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IL 036.125446) |
| 207W00000X Ophthalmology (Licence: GA 062429) | |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2012-04-16 |