| NPI | 1518487784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME149515) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301112953) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2022-07-21 |