| NPI | 1629395892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 276395) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME118846) |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2015-10-23 |