| NPI | 1568608966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101257893) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME103737) |
| Enumeration Date | 2009-01-06 |
| Last Update Date | 2016-02-18 |