| NPI | 1821080722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD066518L) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35075600H) |
| 207W00000X Ophthalmology (Licence: NY 19556601) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2023-03-07 |