| NPI | 1679151617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD230165) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME172404) |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2026-07-15 |