| NPI | 1376520908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AR E-6230) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2005022740) |
| 207W00000X Ophthalmology (Licence: FL ME107401) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2011-08-03 |