| NPI | 1750323747 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: FL ME56260) | 
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME56260) | 
| Enumeration Date | 2006-06-12 | 
| Last Update Date | 2021-07-14 |