| NPI | 1396711511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME97627) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA 055336) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2008-12-09 |