| NPI | 1689705188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 102255) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 102255) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2021-03-30 |