| NPI | 1194861674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX N6331) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD P19720) |
| 207W00000X Ophthalmology (Licence: FL ME 104159) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2011-10-01 |