| NPI | 1699031948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: FL ME134885) |
| Additional Taxonomies | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: OH 35.128406) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2023-11-02 |