| NPI | 1063909158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME161231) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MS 32386) |
| 208D00000X General Practice (Licence: NE 32455) | |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2026-06-04 |