| NPI | 1942277280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 24107) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME148468) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2022-04-04 |