| NPI | 1043231921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 199483) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 035737) |
| 207W00000X Ophthalmology (Licence: NY 199483) | |
| 207W00000X Ophthalmology (Licence: CT 035737) | |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2020-04-29 |