| NPI | 1699894493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME127514) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 124780) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2019-10-16 |