| NPI | 1750776696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME149927) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 70882-20) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2022-11-08 |