| NPI | 1093799611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME91656) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD038774-E) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2015-09-17 |