| NPI | 1154711513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 83664-20) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME144452) |
| Enumeration Date | 2015-01-23 |
| Last Update Date | 2024-06-21 |