| NPI | 1992124929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME142116) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD464105) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2019-09-10 |