| NPI | 1275501157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD027583E) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 162180-1) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2021-03-07 |