| NPI | 1114913829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME86211) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A69742) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2015-01-06 |