| NPI | 1578896155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME116753) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 268735) |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2015-09-22 |