| NPI | 1548275472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 17650) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 27300) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2007-07-08 |