| NPI | 1295096071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301116441) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME131030) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2020-02-21 |