| NPI | 1710199047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 248987) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 226070) |
| 207W00000X Ophthalmology (Licence: CA A104744) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2011-10-26 |