| NPI | 1306163514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: OK 31990) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 274993) |
| 207W00000X Ophthalmology (Licence: FL ME124162) | |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2020-05-26 |