| NPI | 1083989719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME116786) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A117998) |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2013-07-05 |