| NPI | 1710147830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A 121698) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME 109457) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2013-06-24 |