| NPI | 1902802028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ME 011295) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NH 7030) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2007-07-08 |