| NPI | 1619972015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NH 5133) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 57575) |
| 207W00000X Ophthalmology (Licence: TX D5253) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2007-09-07 |