| NPI | 1760533608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101241471) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OK 23993) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2007-07-08 |