| NPI | 1700860905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 192271) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 159550) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2025-08-19 |