| NPI | 1174215701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME160144) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: FL ME160144) |
| Enumeration Date | 2023-05-23 |
| Last Update Date | 2024-06-19 |