| NPI | 1992757991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA 34581) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 52876571205) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2012-04-16 |