| NPI | 1780770156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA 38849) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 51081-20) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2010-06-14 |