| NPI | 1558312462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 89092) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME94281) |
| 208D00000X General Practice (Licence: GA 89092) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2022-04-05 |