| NPI | 1225201155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR 161328) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME112134) |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2021-02-20 |