| NPI | 1073515847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: NY 193410) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 193410) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2021-10-03 |