| NPI | 1679660054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 98-01100) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME 69616) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2007-07-08 |