| NPI | 1942529144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA 141640) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME120046) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2022-05-27 |