| NPI | 1639104318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME79154) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 210778-1) |
| 207W00000X Ophthalmology (Licence: CA G83074) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2022-04-05 |