| NPI | 1528357043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NM RS2013-0363) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MT197844) |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2014-02-19 |