| NPI | 1063614089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.093058) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 42600) |
| 207W00000X Ophthalmology (Licence: FL ME98454) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2009-09-23 |