| NPI | 1306137104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: UT 10785568-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 267576) |
| 207W00000X Ophthalmology (Licence: NH 18060) | |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2021-11-03 |