| NPI | 1629463732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME145554) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA10624000) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2023-09-27 |