| NPI | 1205827540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME17715) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301036790) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2011-06-03 |