| NPI | 1801883822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: FL ME80678) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME0080678) |
| 208000000X Pediatrics (Licence: FL ME0080678) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2017-12-01 |