| NPI | 1760849517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 131906) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 131906) |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2016-01-25 |