| NPI | 1194975177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME109263) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 60 250476) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2021-04-16 |