| NPI | 1407163041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: FL ME115871) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL MFC1667) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2025-11-14 |