| NPI | 1548375579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101231581) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME 84255) |
| 207W00000X Ophthalmology (Licence: TX L0067) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2009-03-09 |