| NPI | 1700043643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 203516) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 62138) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2010-04-07 |