| NPI | 1962459420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 235067) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 227978) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2015-03-31 |