| NPI | 1265458293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME123815) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD17533) |
| 207W00000X Ophthalmology (Licence: CA C52765) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2023-09-11 |