| NPI | 1265944193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME161544) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PR 21524) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: FL ME161544) | |
| 208D00000X General Practice (Licence: PR 21524) | |
| Enumeration Date | 2017-11-01 |
| Last Update Date | 2024-08-26 |