| NPI | 1366936882 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ME MD26571)  | 
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 275986)  | 
| 207W00000X Ophthalmology (Licence: NH 23619)  | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MA 291178)  | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NH 23619)  | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: ME MD26571)  | |
| 174400000X Specialist (Licence: NH 23619)  | |
| 174400000X Specialist (Licence: ME MD26571)  | |
| 207R00000X Internal Medicine (Licence: MA 275986)  | |
| Enumeration Date | 2018-06-18 | 
| Last Update Date | 2024-10-17 |