| NPI | 1104454552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: FL ME175309) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.150630) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2025-09-02 |