| NPI | 1922002872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA 35210) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SD 5250) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2015-04-07 |