| NPI | 1619596970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301517182) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME167975) |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2026-07-15 |