| NPI | 1679991616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 280532) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CT 064772) |
| Enumeration Date | 2014-04-06 |
| Last Update Date | 2023-09-08 |