| NPI | 1639154727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME 103339) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 71471) |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2021-06-04 |