| NPI | 1821298134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 44312) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX N6568) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2011-06-03 |