| NPI | 1689664872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301028076) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI AW028076) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2012-04-19 |