| NPI | 1962451336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 200000285) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 21706) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2009-12-07 |