| NPI | 1558653014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 55952) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 274543) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2021-11-03 |