| NPI | 1467458331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: RI MD11177) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 204964) |
| 207W00000X Ophthalmology (Licence: FL ME71793) | |
| 207W00000X Ophthalmology (Licence: LA L09682R) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2014-04-16 |