| NPI | 1992764187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME170415) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 357044-1205) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2024-10-31 |