| NPI | 1528020880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME70608) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AL 00020279) |
| 207W00000X Ophthalmology (Licence: RI MD09000) | |
| 207W00000X Ophthalmology (Licence: MA 76456) | |
| 207WX0110X Ophthalmology Pediatric Ophthalmology and Strabismus Specialist (Licence: FL ME70608) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2020-04-27 |