| NPI | 1891712337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 63463) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 254422) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2015-05-19 |