| NPI | 1366413023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME137741) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 190065) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2019-01-09 |