| NPI | 1629287040 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301102140) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA R-7958) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2014-08-29 |