| NPI | 1497284731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 296424) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ME MD22505) |
| 207W00000X Ophthalmology (Licence: MO 2023011649) | |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2023-04-20 |