| NPI | 1649253444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 204598) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NH 10852) |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2013-11-25 |