| NPI | 1578513024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME87934) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A86777) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2016-11-28 |