| NPI | 1528058252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN MD0000036018) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 37277) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2016-11-30 |