| NPI | 1174558639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 124673-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 1246732) |
| 207W00000X Ophthalmology (Licence: NY 124678-1) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2019-12-03 |