| NPI | 1013203272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME127081) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2015007985) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2024-09-12 |