| NPI | 1215143771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME106317) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AL 28796) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2010-11-01 |