| NPI | 1093866840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: FL ME166547) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD60136200) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2024-03-01 |