| NPI | 1457685331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: TN 56690) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 241508) |
| 207W00000X Ophthalmology (Licence: FL ME124723) | |
| 207W00000X Ophthalmology (Licence: NM RS2013-0106) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: FL ME124723) | |
| Enumeration Date | 2009-09-25 |
| Last Update Date | 2018-08-07 |