| NPI | 1114900800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME0063902) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AL 12683) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2012-04-19 |