| NPI | 1194753301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 074642) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME101630) |
| 207W00000X Ophthalmology (Licence: AL 26998) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2021-12-17 |