| NPI | 1255599866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME160137) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 253455) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2023-12-26 |