| NPI | 1891889135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 200701661) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 39590) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2008-03-19 |