| NPI | 1154311249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: NY 293445) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 75555) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2018-11-30 |