| NPI | 1790787448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA MD13263R) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA 13263R) |
| 207W00000X Ophthalmology (Licence: GA 041428) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2008-02-26 |