| NPI | 1548290562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 200000102) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2000-00102) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2010-12-20 |