| NPI | 1073509857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: AL MD.43248) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301043309) |
| 207W00000X Ophthalmology (Licence: FL ME126065) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2021-11-02 |