| NPI | 1114116142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME111612) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 101244506) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2017-04-06 |