| NPI | 1013331404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 284130) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 274385) |
| Enumeration Date | 2014-02-06 |
| Last Update Date | 2020-07-02 |