| NPI | 1265638746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 56678) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 25653) |
| 207W00000X Ophthalmology (Licence: FL TRN12604) | |
| 207W00000X Ophthalmology (Licence: FL ME109699) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2013-09-26 |