| NPI | 1457508731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 255212) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 250385) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2013-08-05 |