| NPI | 1720062763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2022-03021) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 227952-1) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2024-05-16 |