| NPI | 1699896167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA OP60127012) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 5101016467) |
| 207W00000X Ophthalmology (Licence: ID O 570) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2010-05-28 |