| NPI | 1326013525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD028357E) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 131307-1) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2019-01-09 |