| NPI | 1407269301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME135030) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT206880) |
| 207W00000X Ophthalmology (Licence: PA MT206880) | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2018-03-17 |