| NPI | 1578763983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME115166) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CO 49939) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2017-05-05 |