| NPI | 1538165659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: RI md5399) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 38194) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2011-09-20 |