| NPI | 1407161771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.099598) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME133578) |
| 207W00000X Ophthalmology (Licence: VA 0116023061) | |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2018-06-07 |