| NPI | 1730162140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ME MD17756) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 200100197) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2023-01-10 |