| NPI | 1124384714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: NY 283416) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 283416) |
| 207W00000X Ophthalmology (Licence: VT 042.0013494) | |
| 207W00000X Ophthalmology (Licence: MA 266886) | |
| Enumeration Date | 2012-04-08 |
| Last Update Date | 2021-08-09 |