| NPI | 1346622586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A179340) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-263998) |
| 207W00000X Ophthalmology (Licence: FL ME140939) | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2022-09-13 |