| NPI | 1558451047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME114600) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AR E-3505) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2013-04-18 |