| NPI | 1235126186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME102185) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35076811) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME102185) | |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2020-02-07 |