| NPI | 1831461458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: FL ME158220) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301106794) |
| 207W00000X Ophthalmology (Licence: PA MD461141) | |
| 207W00000X Ophthalmology (Licence: NY 297595) | |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2022-09-21 |