| NPI | 1811068497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PR 16466) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX M4623) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2016-09-15 |