| NPI | 1457715237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35143118) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME144412) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2021-08-13 |