| NPI | 1003952466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME103910) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD P21410) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2021-04-14 |