| NPI | 1831367390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX 44217) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2012010197) |
| Enumeration Date | 2008-02-18 |
| Last Update Date | 2013-11-18 |