| NPI | 1972693562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA C53304) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 5045674-1205) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2009-06-04 |