| NPI | 1457348781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 222151) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 222151) |
| 207W00000X Ophthalmology (Licence: PA MD061598L) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: PA MD061598L) | |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2022-11-15 |