| NPI | 1104030055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A105824) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 6444) |
| 207W00000X Ophthalmology (Licence: FL ME110731) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2015-10-13 |