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 |