| NPI | 1578183976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 69103) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125075922) |
| 207W00000X Ophthalmology (Licence: FL ME166924) | |
| Enumeration Date | 2020-04-26 |
| Last Update Date | 2025-06-27 |