| NPI | 1265013452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301514622) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ME MD30285) |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2026-04-15 |