| NPI | 1225325129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A133985) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 262015) |
| 207W00000X Ophthalmology (Licence: FL ME119895) | |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2015-06-07 |