| NPI | 1386645224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME90057) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 29828) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2020-06-01 |