| NPI | 1790888006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A125489) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2008017344) |
| 207W00000X Ophthalmology (Licence: HI MD-15590) | |
| 207W00000X Ophthalmology (Licence: MD D74915) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2013-07-16 |