| NPI | 1316028335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME96228) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL trn6699) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2011-12-22 |