| NPI | 1447253703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ME 014945) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX D4200) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2010-10-22 |