| NPI | 1982629937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 229157) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME92822) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2008-06-09 |