| NPI | 1558478586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME0062097) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL 62097) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2021-03-23 |