| NPI | 1457810376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: NY 319018) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 73321) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-06-16 |