| NPI | 1912994658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 34394) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: RI MD05069) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2015-09-21 |