| NPI | 1689934127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 55031) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 291443) |
| 207WX0107X Ophthalmology Retina Specialist (Licence: NY 291443) | |
| 207WX0107X Ophthalmology Retina Specialist (Licence: CT 55031) | |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2022-01-20 |