| NPI | 1063414589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 154517) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 154517) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2025-09-11 |