| NPI | 1649398579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC LL 29061) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL 29061) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2013-01-28 |