| NPI | 1750484861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 150884) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: RI MD10994) |
| 207W00000X Ophthalmology (Licence: CT 041378) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2024-02-07 |