| NPI | 1821281395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 275200-1) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101249643) |
| Enumeration Date | 2007-08-19 |
| Last Update Date | 2015-04-14 |