| NPI | 1740259209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO R4770) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 26658) |
| 207W00000X Ophthalmology (Licence: NE 12232) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2007-12-04 |