| NPI | 1922418904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME165056) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA 155316) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2025-08-13 |