| NPI | 1922299114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME116091) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL TRN12955) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2013-05-21 |