| NPI | 1871589366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VT 042-0005295) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NH 5606) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2007-07-08 |