| NPI | 1053317263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 215371) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: RI MD12036) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2020-06-10 |