| NPI | 1821085457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 29931) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TN 39585) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2010-09-03 |