| NPI | 1790835387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL OS11619) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NE 553) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2012-06-21 |