| NPI | 1790276780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: NY 314593) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4351034422) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2024-08-05 |