| NPI | 1982654505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 35800) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 16171) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2009-12-07 |