| NPI | 1710206057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101255729) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD447489) |
| 207W00000X Ophthalmology (Licence: FL ME127152) | |
| 207WX0107X Ophthalmology Retina Specialist (Licence: VA 0101255729) | |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2019-06-12 |