| NPI | 1255599601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME163188) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA MD.204904) |
| 207W00000X Ophthalmology (Licence: MS 21687) | |
| Enumeration Date | 2008-06-01 |
| Last Update Date | 2023-07-26 |