| NPI | 1174771653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME112533) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PR 18067) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2018-06-15 |