| NPI | 1770877284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME150884) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 283394) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2022-08-02 |