| NPI | 1255367959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME99734) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301039556) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2011-05-24 |