| NPI | 1689662751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 035393) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 200300015) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2015-08-12 |