| NPI | 1063611739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME112489) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX P0008) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2016-12-05 |