| NPI | 1922006337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME135894) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PR 11435) |
| Enumeration Date | 2005-07-09 |
| Last Update Date | 2018-11-28 |