| NPI | 1356395404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME135486) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA 13072R) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2021-03-30 |