| NPI | 1740389279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AL 00014412) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 033554) |
| 207W00000X Ophthalmology (Licence: OH 35051354) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2007-07-08 |