| NPI | 1811992019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 221211-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 221211-2) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2020-01-28 |