| NPI | 1366746166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME128049) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL TRN15331) |
| Enumeration Date | 2011-01-07 |
| Last Update Date | 2016-08-26 |