| NPI | 1174747059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2013-01062) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME101111) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2021-03-31 |