| NPI | 1295706570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: FL ME111496) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CO 40139) |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: CO 40139) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2021-11-08 |