| NPI | 1174797468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 270838) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 239164-1) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2021-12-27 |