| NPI | 1902837115 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME0043510)  | 
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME0043510)  | 
| Enumeration Date | 2006-07-05 | 
| Last Update Date | 2017-01-03 |