| NPI | 1205035144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME115962) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 002349) |
| 207W00000X Ophthalmology (Licence: NY 257190) | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2022-10-06 |