| NPI | 1396035648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 9681285-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA ML50224001) |
| 207W00000X Ophthalmology (Licence: FL ME123105) | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2018-03-17 |