| NPI | 1518596741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301511282) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME167363) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2026-08-06 |