| NPI | 1306867387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 60671) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME80880) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2018-06-13 |