| NPI | 1588612253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 027495) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA 015763) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2007-07-08 |