| NPI | 1487614251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: RI MD03705) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 219972) |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2012-05-03 |