| NPI | 1720260151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX N2271) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME 101350) |
| 207W00000X Ophthalmology (Licence: LA md200353) | |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2013-08-06 |