| NPI | 1518097815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MS 20249) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 59069) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2009-02-02 |