| NPI | 1336364256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 049978) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 235740) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2011-10-04 |