| NPI | 1952304156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101053550) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DC MD31450) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2007-07-08 |