| NPI | 1275504615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD050522L) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 164439-1) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2021-03-30 |