| NPI | 1730599903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME140865) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD464282) |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2019-07-22 |