| NPI | 1093715302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: FL ME50469) |
| Additional Taxonomies | 156FX1100X Technician/Technologist Ophthalmic (Licence: NY 150494) |
| 156FX1100X Technician/Technologist Ophthalmic (Licence: CA G59946) | |
| 156FX1100X Technician/Technologist Ophthalmic (Licence: FL ME50469) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2020-08-05 |