| NPI | 1316275092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD439237) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 256582) |
| Enumeration Date | 2009-11-18 |
| Last Update Date | 2021-12-15 |