| NPI | 1619977345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME0064370) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: FL ME64370) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: GA 37090) | |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2017-04-05 |