| NPI | 1295960946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME114955) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN13800) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2022-03-04 |