| NPI | 1669675229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 7963337-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 269311) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2021-10-19 |