| NPI | 1053541946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME115563) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX 539231) |
| Enumeration Date | 2009-07-25 |
| Last Update Date | 2016-09-21 |