| NPI | 1760944185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 327024) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME161779) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2024-08-19 |