| NPI | 1225171010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: CO DR.0052297) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 006819tuv) |
| 207W00000X Ophthalmology (Licence: NY 258883) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2017-03-30 |