| NPI | 1710171434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A108603) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2008012513) |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2013-02-28 |