| NPI | 1174714836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME106542) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2007012267) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2012-07-02 |