| NPI | 1235459512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 071630) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 267234) |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2021-10-21 |