| NPI | 1598718553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME102736) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA 13218R) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2015-12-02 |