| NPI | 1528075702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 36588) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME96112) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2011-12-13 |