| NPI | 1124319066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: FL ME132807) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME132807) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NY 270516) | |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2026-03-04 |