| NPI | 1972707552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A106150) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX BP2-0023374) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2009-08-13 |