| NPI | 1326257569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: CA A114509) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME103981) |
| 207W00000X Ophthalmology (Licence: CA A114509) | |
| 207W00000X Ophthalmology (Licence: MI 4301088814) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2021-04-05 |