| NPI | 1407846330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME107767) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.084805) |
| 207W00000X Ophthalmology (Licence: OH 35.084805) | |
| 207W00000X Ophthalmology (Licence: GA 64380) | |
| Enumeration Date | 2005-10-23 |
| Last Update Date | 2020-06-01 |