| NPI | 1730479650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME130764) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 77496) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: GA 77496) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: FL ME130764) | |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2023-04-20 |