| NPI | 1215060736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME38137) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA 033155E) |
| 207W00000X Ophthalmology (Licence: NJ 25MA04568500) | |
| 207W00000X Ophthalmology (Licence: CT 053554) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2015-10-08 |