| NPI | 1487158556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2023032158) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME155896) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2025-01-09 |