| NPI | 1558415067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101247650) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL 39020000X) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2014-08-08 |