| NPI | 1598764151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME29272) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME029272) |
| Enumeration Date | 2005-07-17 |
| Last Update Date | 2013-03-27 |