| NPI | 1629033972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 20457) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 32762) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2014-02-17 |