| NPI | 1417939067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME141272) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AL 52732) |
| 207W00000X Ophthalmology (Licence: IA 24873) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2025-12-17 |