| NPI | 1114247079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: FL ME123691) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME123691) |
| 207W00000X Ophthalmology (Licence: GA 74257) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: GA 74257) | |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2017-04-05 |