| NPI | 1235672585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: FL ME133059) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL MFC1768) |
| Enumeration Date | 2016-11-18 |
| Last Update Date | 2021-03-30 |