| NPI | 1487631362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 100373) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VT 042004420) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2007-07-08 |