| NPI | 1063770469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME126967) |
| Additional Taxonomies | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: FL ME126967) |
| 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: NY 277734) | |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2019-09-16 |