| NPI | 1417236860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 156FX1700X Technician/Technologist, Ocularist |
| 229N00000X Anaplastologist | |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2018-09-19 |