| NPI | 1821010307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 155074-1) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 155074) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2021-11-15 |