| NPI | 1265923486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME158379) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA R-11138) |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2022-08-15 |