| NPI | 1831861319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: NY 313207) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 313207) |
| Enumeration Date | 2021-10-02 |
| Last Update Date | 2023-07-07 |