| NPI | 1790702769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 55473) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ MA067450) |
| 207W00000X Ophthalmology (Licence: SC AL34173) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2016-09-20 |