| NPI | 1962504811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2011-00214) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO T2006015660) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2011-05-12 |