| NPI | 1164522793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME 64994) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2005-01163) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2010-04-01 |