| NPI | 1184908691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 302643) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME127788) |
| 207W00000X Ophthalmology (Licence: ND 14582) | |
| Enumeration Date | 2011-10-03 |
| Last Update Date | 2024-01-10 |