| NPI | 1922017870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 13302R) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 030618) |
| 207W00000X Ophthalmology (Licence: NC 12691) | |
| 207W00000X Ophthalmology (Licence: AL 14945) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2007-07-08 |