| NPI | 1013234624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME125837) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: GA ME125837) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2026-02-14 |