| NPI | 1598762981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME51999) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: FL 51999) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2018-10-22 |