| NPI | 1780032839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX T7917) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME145099) |
| 207WX0107X Ophthalmology Retina Specialist (Licence: FL ME145099) | |
| 207WX0107X Ophthalmology Retina Specialist (Licence: TX T7917) | |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2022-07-18 |