| NPI | 1578544136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G054094) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD-041308E) |
| 207W00000X Ophthalmology (Licence: MA 51273) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2007-10-26 |