| NPI | 1265519995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME0071328) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD440020) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-07-18 |