| NPI | 1699878587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 106798) |
| Additional Taxonomies | 156FX1100X Technician/Technologist, Ophthalmic (Licence: NY 106798) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2015-02-09 |