| NPI | 1821176959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD439951) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL TRN9942) |
| 207W00000X Ophthalmology (Licence: FL ME103721) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2022-11-18 |