| NPI | 1669467759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX D3307) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX D3307) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2014-06-27 |