| NPI | 1760419899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME71349) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME71349) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2019-01-15 |