| NPI | 1932105483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 03517R) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX D4157) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2008-02-28 |