| NPI | 1548474018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VT 0420011773) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 250434) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2014-02-16 |