| NPI | 1417935511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME123220) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 30264) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2023-04-11 |