| NPI | 1255309704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: FL ME85244) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME85244) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2017-04-12 |