| NPI | 1568552297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2012-02008) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA L7761R) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2013-04-30 |