| NPI | 1649492711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME98906) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 241927) |
| 207W00000X Ophthalmology (Licence: MD D65142) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: FL ME98906) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2019-03-12 |