| NPI | 1629279864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A91049) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: RI MD13082) |
| 207W00000X Ophthalmology (Licence: MA 231620) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2023-03-07 |