| NPI | 1619085008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 116766) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 116766) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2024-08-28 |